Valerie Møller

Use of indigenous and indigenised medicines to enhance personal well-being: a South African case study.

An estimated 27 million South Africans use indigenous medicines (Mander, 1997, Medicinal plant marketing and strategies for sustaining the plant supply in the Bushbuckridge area and Mpumalanga Province. Institute for Natural Resources, University of Natal. Pietermaritzburg, South Africa). Although herbal remedies are freely available in amayeza stores, or Xhosa chemists, for self-medication, little is known about the motivations of consumers. According to African belief systems, good health is holistic and extends to the persons social environment. The paper makes a distinction between traditional medicines which are used to enhance personal well-being generally and for cultural purposes, on the one hand, and medicines used to treat physical conditions only, on the other. Drawing on an eight-month study of Xhosa chemists in Eastern Cape Province, South Africa, in 1996, the paper identifies 90 medicines in stock which are used to enhance personal well-being. Just under one-third of all purchases were of medicines to enhance well-being. Remedies particularly popular included medicines believed to ward off evil spirits and bring good luck. The protection of infants with medicines which repel evil spirits is a common practice. Consumer behaviours indicate that the range of medicines available is increased by indigenisation of manufactured traditional medicines and cross-cultural borrowing. Case studies confirm that self- and infant medication with indigenous remedies augmented by indigenised medicines plays an important role in primary health care by allaying the fears and anxieties of everyday life within the Xhosa belief system. thereby promoting personal well-being.

TB treatment initiation and adherence in a South African community influenced more by perceptions than by knowledge of tuberculosis.

BackgroundTuberculosis (TB) is a global health concern. Inadequate case finding and case holding has been cited as major barrier to the control of TB. The TB literature is written almost entirely from a biomedical perspective, while recent studies show that it is imperative to understand lay perception to determine why people seek treatment and may stop taking treatment. The Eastern Cape is known as a province with high TB incidence, prevalence and with one of the worst cure rates of South Africa. Its inhabitants can be considered lay experts when it comes to TB. Therefore, we investigated knowledge, perceptions of (access to) TB treatment and adherence to treatment among an Eastern Cape population.MethodsAn area-stratified sampling design was applied. A total of 1020 households were selected randomly in proportion to the total number of households in each neighbourhood.ResultsTB knowledge can be considered fairly good among this community. Respondents perceptions suggest that stigma may influence TB patients decision in health seeking behavior and adherence to TB treatment. A full 95% of those interviewed believe people with TB tend to hide their TB status out of fear of what others may say. Regression analyses revealed that in this population young and old, men and women and the lower and higher educated share the same attitudes and perceptions. Our findings are therefore likely to reflect the actual situation of TB patients in this population.ConclusionsThe lay experts perceptions suggests that stigma appears to effect case holding and case finding. Future interventions should be directed at improving attitudes and perceptions to potentially reduce stigma. This requires a patient-centered approach to empower TB patients and active involvement in the development and implementation of stigma reduction programs.

The Relationship between Subjective Well-being and Domain Satisfactions in South Africa

This paper examines the relationship between subjective well-being and domain satisfactions. In the past different models have been specified. The most commonly applied model is the bottom-up model in which domain satisfactions affect subjective well-being. The more recent top-down model suggests a reversed relationship. Finally there is the supposition that the correlations between these variables can be spurious due to the effect of personality characteristics. Empirical research has shown that different models are found for different domains and in different countries. Focussing on the effects of the domain satisfactions of finances, housing and social contacts it has been found that subjective well-being is mainly affected by satisfaction with social contacts in Western developed countries and by satisfaction with finances in East European countries. The question we should like to answer in this study is whether a similar pattern obtains for the factors which influence subjective well-being among the different race groups in South Africa. Interestingly, coloured people and Asians did indeed show the expected effects but the groups with the most extreme living conditions did not. Evaluation of life circumstances by black and white South Africans was determined by expectations for the future rather than by current living conditions. This surprising result is discussed in the light of the political situation in South Africa.

Individual- and Neighbourhood-Level Indicators of Subjective Well-Being in a Small and Poor Eastern Cape Township: The Effect of Health, Social Capital, Marital Status, and Income

Our study used multilevel regression analysis to identify individual- and neighbourhood-level factors that determine individual-level subjective well-being in Rhini, a deprived suburb of Grahamstown in the Eastern Cape province of South Africa. The Townsend index and Gini coefficient were used to investigate whether contextual neighbourhood-level differences in socioeconomic status determined individual-level subjective well-being. Crime experience, health status, social capital, and demographic variables were assessed at the individual level. The indicators of subjective well-being were estimated with a two-level random-intercepts and fixed slopes model. Social capital, health and marital status (all pxa0<xa0.001), followed by income level (pxa0<xa0.01) and the Townsend score (pxa0<xa0.05) were significantly related to individual-level subjective well-being outcomes. Our findings showed that individual-level subjective well-being is influenced by neighbourhood-level socioeconomic status as measured by the Townsend deprivation score. Individuals reported higher levels of subjective well-being in less deprived neighbourhoods. Here we wish to highlight the role of context for subjective well-being, and to suggest that subjective well-being outcomes may also be defined in ecological terms. We hope the findings are useful for implementing programs and interventions designed to achieve greater subjective well-being for people living in deprived areas.

The Role of Quality of Life Surveys in Managing Change in Democratic Transitions: The South African Case

The South African Quality of Life Project has tracked subjective well-being, life satisfaction and happiness, since the early eighties at the national level. In most democratic countries around the globe, the average citizen says he or she is satisfied with life in general. In South Africa this is not the case. Since the early 1980s, the trend study shows up disparities between one sector of the South African population that is satisfied with life in general and various aspects of life and another sector that is very dissatisfied. Generally, the better-off report higher levels of satisfaction and happiness than the worse-off. The most plausible explanation for the South African quality-of-life constellation is the huge gap in living standards between rich and poor, a legacy of the apartheid era, which discriminated against blacks and to a lesser extent against Indian and coloured people. Euphoria following on the first democratic elections in April 1994, which registered equally high aggregate levels of happiness and life satisfaction among all sectors of the population, was short-lived. Under democracy, expectations “for a better life for all”, the election slogans for the 1994 and 1999 general elections, has risen. South Africa has one of the most enlightened constitutions, which guarantees basic human rights and supports advancement of the previously disadvantaged. As long as South Africans perceive barriers to accessing the material rewards of democracy, they do not see justice has been done. South Africa is currently grappling with problems common to other societies in transition to democracy. Since 1994, government programmes and policies have been devised to address the critical twin problems of poverty and inequality in society. The latest round of research for the South African Quality of Life Trends Project probes popular assessments of the policies and programmes aimed at improving the quality of life of ordinary South Africans. Interviews with a panel of 25 opinion leaders in the run-up to the June 1999 general elections were followed by a nationally representative opinion survey in October 1999. The paper outlines the role of social indicators in monitoring quality of life in South Africa and reports findings from the elite and rank-and-file surveys. Generally, the winners and losers in the new political dispensation see changes from a different perspective. The disadvantaged are more likely to have seen material gains and recommend increased delivery of services and opportunities for social mobility. The advantaged, who have mainly experienced non-material or no gains since 1994, are more likely to be pessimistic about the future. It is concluded that the grounds well of optimism will sustain the majority of South Africans who are still dissatisfied with life until their dreams of the good life are fulfilled.

South Africa's ''Rainbow People'', National Pride and Happiness

Since the first free elections were held in April 1994, South Africans are popularly known as the rainbow people. The paper inquires whether South Africans who experienced pride in their nation in the first years of democracy also perceived a greater sense of subjective well-being. It is proposed that national pride in post-apartheid South Africa might be fused with or work through self-esteem to lift levels of happiness. The paper traces the history of the new integrating civil religion of the rainbow people and the acceptance of the rainbow as a political symbol of unity among the diverse people of South Africa immediately after the 1994 elections and two years later. The proposed link between national pride and happiness was explored with data from two independent national surveys, the 1995 South African World Values Survey conducted by Markinor and a June 1996 MarkData syndicated omnibus survey. The study found that the appeal of the rainbow as political symbol was inclusive of all groups in society and that feelings of national pride and support for the rainbow ideal were positively associated with subjective well-being. As indicated by intensity and frequency measures, the majority of South Africans were proud of their country and could name a national achievement that inspired pride. Better-off South Africans tended to be happier and more satisfied with life but less proud, while the poor were less happy but fiercely proud of their country. Results suggest that belief in South Africas rainbow nation ideal may have assisted in boosting happiness during the transition to a stable democracy, thereby preventing alienation among the losers under the new political dispensation. Supporters of the ideal of the rainbow nation were more optimistic than others about the future of their country.

Stigma associated with tuberculosis in a time of HIV/ AIDS: Narratives from the Eastern Cape, South Africa

Abstract A pilot study, conducted in early 2006, explored perceptions of the stigma associated with tuberculosis (TB) in the Eastern Cape, a province of South Africa characterised by high levels of poverty and unemployment where TB is endemic. Focus group discussions conducted with residents of Grahamstown East, Makana, shed light on the manner in which stigma and discrimination is perceived to impact on the control of TB. Participants in the study represented a mix of generations, socio-economic backgrounds, and bio-medical and lay knowledge of TB. Stigma was spontaneously identified as a factor that competed with the burden of disease to discourage individuals to present for and complete treatment. The study found that the stigma associated with TB had come full circle in the Eastern Cape. Apparently, TB was stigmatised in the past when it was known mainly as an incurable ‘Xhosa disease’. TB lost its stigma when a cure was found, only later to be restigmatised as a marker of AIDS. Uncertainty surrounding the diagnosis and cure of TB for persons coinfected with HIV contributed to prejudice. By consensus, AIDS was characterised as a ‘killer’ disease. Similarly, TB was seen to be a very serious condition that could be fatal if not treated or diagnosed in time. However, in line with public health messages, TB was also projected as a curable and therefore less serious disease if the prescribed course of treatment was completed. The spread of TB and the incidence of multi-drug resistant TB were attributed mainly to the irresponsible behaviour of non-compliant TB patients and the AIDS epidemic. A question for future research is whether the new threat of extremely drug resistant (XDR-) TB will modify attitudes and the prospects of fighting the disease.

South Africa's `Rainbow People', National Pride and Optimism: A Trend Study

Since the first democratic elections of1994, South Africans are popularly known as the`rainbow people. The paper reports theacceptance of the rainbow as political symbolof unity among the diverse people of SouthAfrica at three times: Immediately after the1994 elections, two years later in 1996, andfive years later in 1999 after the secondgeneral elections. The database for the studyare responses to items placed with a syndicatednational survey conducted countrywide. Thepublic discourse on the rainbow is reviewedthrough personal interviews with a panel of 25elites contacted in the run-up to the secondgeneral elections. The researchers revisitconclusions based on the earlier results(Møller, Dickow and Harris, 1999). The thirdround of research finds that the appeal of therainbow as political symbol has waned but isstill inclusive of all groups in society.Projections of national pride have shifted fromthe rainbow as symbol of unity andreconciliation to other icons of achievementsuch as the Reconstruction and DevelopmentProgramme and prowess in sport. Support for thepolitical symbolism of the rainbow ispositively associated with happiness, lifesatisfaction and optimism. Lack of a focus ofnational pride is associated with pessimism.Results support the conclusion reached earlierthat belief in the `rainbow nation idealboosts optimism and promotes happiness duringSouth Africas transition to a stabledemocracy, thereby preventing alienation amongthe losers under the new politicaldispensation. Linkages between acceptance ofthe rainbow symbol, subjective well-being andoptimism are discussed in the light of thesocio-political changes which have taken placein South Africa since democracy.

Improving Subjective Well-being of the Poor in the Eastern Cape

This study investigated the effects of income, health, social capital, marital status, employment, education and crime experience on subjective well-being within a poor community in the Eastern Cape of South Africa. It appeared that higher income is associated with higher subjective well-being and that social capital serves as an important subjective well-being predictor in all income groups. Efforts must be made to ensure that countries do not develop economically at the expense of other aspects of life important for well-being in the very poor, such as social capital.

South African quality of life trends in the late 1990s: major divides in perceptions

The majority of South Africas population registered dissatisfaction with life overall and with most aspects of life under apartheid. Life satisfaction and happiness peaked in 1994 after the first-ever open general elections. However, election euphoria was short-lived. The Quality of Life Trends Project launched in the early eighties has produced subjective indicators to chart progress in achieving the new governments goal of a ‘better life for all’. The paper reports trend data from successive national sample surveys which suggest that the new set-levels of life satisfaction and happiness may be rising among the formerly disadvantaged groups in South African society but still fall short of the 1994 peak level. Happiness and life satisfaction continue to decline among the formerly advantaged groups. The latest results from the Quality of Life Trends Project are examined in the light of the argument that South Africa is still divided in ‘two nations’ white and black, and rich and poor. The conclusion is d...